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Endoscopy’s future

BioPhotonicsOct 2006
In a review, Dr. Michael
V. Sivak Jr. of Case Western Reserve University in Cleveland predicted the future
of endoscopy by drawing upon the history of the discipline. He noted that advancements
in endoscopy may slow or stop.

Sivak called 1968 to 1990 the “golden
era of gastrointestinal endoscopy” because so many devices and procedures
were developed in this period. New endoscopic techniques arose primarily from direct
collaborations between clinicians and artisan-engineers. Advances mostly stemmed
from incorporating technologies developed for other disciplines, such as the CCD.

Around 1980, endoscopy was combined
with ultrasonography for the first time. While previous innovations had improved
only the visual inspection of the gut, endoscopic ultrasonography employed a new
method of diagnosis. Sivak believes that the technology serves as a model for innovation
and that future techniques will become more focused, perhaps on a single disease.
However, nongastroenterologists have not completely accepted endoscopic ultrasonography
because of a relative lack of controlled trials that would illustrate its benefit.

The gastroenterological achievements
between 1994 and 2004 were fewer in number than in the golden era, and few were
advancements in diagnosis and treatment methods.

Sivak cited a number of reasons why
endoscopic technology may reach a plateau. Endoscopists are becoming older, and
fewer new endoscopists are entering the field. Manufacturers of endoscopes and of
related devices are becoming larger but decreasing in number. Additionally, endoscopic
research has received less federal funding. Sivak blamed the lack of funding on
the failure of researchers to design clinical trials that demonstrate the benefit
of endoscopic technology.

He predicted several things for endoscopy.
Nurses will perform routine procedures instead of physicians, reducing the latter’s
workloads. Endoscopes will be designed for hands-free operation, enabling more complex
therapeutic procedures. A variety of combined laparoscopic-endoscopic procedures
will be developed.

Sivak also foretold that several biological
detection methods may change endoscopy, including optical coherence tomography,
laser-induced light scattering technology, light-induced fluorescence microscopy
and Raman spectroscopy. In addition, endoscopy may be used with photodynamic therapy.
Computer advancements, including better training simulators, will improve endoscopy
as well.

Ultimately, Sivak believes that traditional
diagnostic endoscopy may be replaced by a combination of virtual imaging and capsule
endoscopy. (Gut, August 2006, pp. 1061-1064).